Association between community outpatient clinic care accessibility and the uptake of diabetic retinopathy screening: A multi-level analysis

Aims: To investigate the uptake rate variance of fundus examination for diabetes-related complications among demographically and geographically diverse communities and examine determinants that influence this rate focusing on outpatient eye care clinic accessibility at community level. Methods: Data of 20,904 participants with diabetes from 228 communities in 2015 were collected from the nationwide Community Health Survey and Statistics Korea. Outpatient eye care clinic accessibility was measured by the number of eye clinics per 1000 population. Multilevel analysis was conducted to assess the fundus examination uptake rate across communities and examine the association of individual and community-level determinants with this rate. Results: The uptake rate among patients with diabetes was 34.8% and varied across communities. At the individual level, determinants related to knowledge and awareness were significantly positively associated with fundus examination uptake. At the community level, increases in the number of eye clinics were associated with significant increases in fundus examination uptake (OR 1.21; 95% CI 1.03-1.43). Conclusions: Based on the result that outpatient eye care clinic accessibility was significantly associated with the uptake rate across communities, improving accessibility may be an important factor and should be considered when developing interventions for promoting regular diabetic retinopathy screening. This will lead to earlier detection of complications and minimize diabetes-related visual impairment. (C) 2020 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.